What You Need to Know About Vaginal Tearing During Childbirth

Scared of getting a tear down there? Here’s why perineal tears happen—and what you can do about them.

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Certain aspects of childbirth aren't spoken about as often as they should be. One of those is a vaginal tear, also called a perineal tear or laceration, which is an injury that can happen to your vagina, vulva, perineum, and anus when giving birth.

"It's important to normalize the notion of vaginal tearing and not to fear it because it happens so often," says Katie Page, CNM, FACNM, a certified nurse-midwife in Forest, Virginia.

You may be wondering how to prevent tearing during birth. The truth is, that's not always possible. But here are the facts about vaginal and perineal tears so you know what to expect down there before and after birth.

What Is Vaginal Tearing?

A perineal or vaginal tear is a laceration to the perineum (the area between the vaginal opening and anus) that can occur when a baby is born vaginally. The tears are spontaneous, meaning a health care provider didn't make a cut (an episiotomy).

Perineal tears can occur when you actively push or sometimes as a result of involuntary uterine contractions delivering the baby.

"During birth, the vagina has to stretch enough to allow a baby, whose head is the size of a cantaloupe, to come through it," says Sherry Ross, MD, an OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California. "Hopefully, the vagina will stretch just enough without tearing, but often a tear does happen."

How Common Is Tearing During Birth?

Vaginal tearing during birth is common. Research shows it occurs in up to 80% of pregnant people who have a vaginal birth. Those giving birth for the first time are more likely to experience a perineal tear than those who have already delivered a baby vaginally.

The good news? "Typically, after your first vaginal birth, your tissue is more flexible, so tearing becomes less likely," Dr. Ross says.

What Causes Vaginal Tears?

Perineal tears can occur for various reasons. Research has found that the following increases the risk of tearing:

  • Older maternal age
  • Mediolateral episiotomy (a cut done at an angle rather than straight back)
  • It’s your first delivery
  • A large baby 
  • A fast delivery
  • Prolonged pushing
  • Having a vacuum delivery or use of forceps

What Are the 4 Types of Vaginal Tears?

There are four degrees of vaginal or perineal tears, and they can range from mild lacerations in the vaginal lining to deep cuts that affect the anal sphincter. Luckily, the most common lacerations aren't the most severe.

First-degree tear

A first-degree tear is considered the least severe. They are superficial and impact only the first layer around the perineal area. Most of the time, no stitches are required for this type of tear.

First-degree tears are usually so small that they don't cause much or any discomfort. In fact, often, people don't even know they have them. You should still expect mild pain during the recovery process when sitting up, having a bowel movement, coughing, or sneezing. You should be feeling better in a couple of weeks.

Second-degree tear

Second-degree tears are the most common type of vaginal tear. These tears involve the vaginal lining and deeper tissues and usually require stitches.

Like with a first-degree perineal tear, you can expect some discomfort when sitting up, having a bowel movement, or doing anything that causes an increase in downward pressure. Within a few weeks, the tear should be pretty well healed, and the stitches will have dissolved.

Third-degree tear

A third-degree perineal tear goes into the deeper layers of the vagina, as well the muscles of the anal sphincter. "Your doctor will need to sew each layer separately, with special attention to closing the muscle layer supporting the sphincter," says Dr. Ross.

Third-degree tears are further categorized by how severely the anal sphincter is affected:

  • 3a: Less than half of the external anal sphincter is torn
  • 3b: More than half of the external anal sphincter is torn
  • 3c: Both the external and internal anal sphincters are torn

Expect four to six weeks of recovery time with pain. It’s possible to experience several months of discomfort with bowel movements and penetrative sex.

Fourth-degree tear

Fourth-degree perineal tears are the most severe as the tear extends to the rectal lining. "This is a very delicate and thorough repair that involves multiple closing layers," says Dr. Ross. "Thankfully, this is the least common tear experienced. Generally, third- and fourth-degree tears happen when the baby's shoulder gets stuck or when a vacuum or forceps are used."

Severe tears into the vagina or rectum can cause:

  • Chronic perineal pain
  • Stool incontinence
  • Gas incontinence
  • Sexual inactivity due to pain
  • Insomnia

Since adequate treatment improves the chances of full recovery, it's essential to share your symptoms with your health care provider.

Healing From Vaginal Tears

Keep in mind healing can be a longer process. "The nerves and full strength of the muscles can take several more weeks to heal," says Page. Sex at six weeks will likely be uncomfortable, too, depending on the location of the vaginal tear and the quality of the stitching.

Can Vaginal Tears During Childbirth Be Prevented?

There's no way to completely prevent a vaginal tear. But you may be able to decrease the severity of vaginal tearing.

Focus on your labor position

Try to get into a labor position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says. Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too.

Lead the pushing phase

It also helps if you lead the pushing phase of labor. When you take the lead, you do just enough for you to feel your baby move, which allows the vagina to stretch slowly, reducing the likelihood of tearing, says Page.

On the flip side, when you're coached to push as hard as you can while someone counts, there's a lot of additional pressure on your perineum, which can increase the chances of tearing.

Use a warm compress

You may reduce your odds of perineal tears by applying a warm compress to the perineum during the pushing phase of labor, says Dr. Ross.

Try a perineal massage

Four to six weeks before your due date (and providing you can reach!), you can practice a 10- to 15-minute perineal massage daily. "Frequently massaging the base of the vagina with oil or a water-based lubricant is thought to soften the tissue, making it more supple and improving its flexibility," says Page.

Some studies have found that using perineal massage reduced the need for episiotomies and the duration of second-stage labor. Researchers believe it is a safe, low-cost, and effective technique for reducing perineal tears.

Always consult your health care provider before beginning the practice, especially if you have a history of herpes, as practicing perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract.

Should I Ask for an Episiotomy?

Health care providers used to routinely perform episiotomies—an incision made in the perineum to widen the vaginal opening to allow more room for the baby to pass through—in hopes it would reduce perineal tearing. They believed it allowed for a more controlled environment that could heal properly.

While an episiotomy is still sometimes necessary, it is no longer routine during a vaginal delivery, says Dr. Ross. In 2006, ACOG recommended against routine episiotomy, and since that time, rates have fallen.

What's more, an episiotomy may actually worsen the damage and the healing process. Most experts advise against an episiotomy unless there's a medical need.

How To Care for Vaginal Tears During Your Recovery

It's normal to feel discomfort as you heal from a vaginal tear. ACOG says the following can help in your recovery:

  • Apply ice packs or cold compresses to the area.
  • Try a sitz bath in warm water and sit in it for a few minutes.
  • Apply witch hazel pads to the area.
  • Take pain relievers, like ibuprofen.
  • Sit on a pillow or special cushion to relieve pressure on the area.
  • Use a "peri bottle" with warm water to clean the area when you use the bathroom.
  • If breastfeeding, try lying on your side to avoid putting pressure on your perineum.
  • Ask a health care provider about stool softeners to help with bowel movements and numbing sprays for the pain.

When To Call a Health Care Provider

Complications can occur after a vaginal tear. Signs that warrant a call to your provider include:

  • You develop a fever
  • Your pain becomes worse
  • You have painful intercourse after you’re cleared to have sex
  • You experience fecal incontinence
  • It hurts to pee
  • Your stitches start to smell
Updated by Anna Halkidis
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Sources
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